Scedosporium boydii finding in an immunocompromised patient and review of the literature / Hallazgo de Scedosporium boydii en un paciente inmunocomprometido y revisión de la literatura

Background Scedosporiasis is an emerging mycosis that has gained importance in recent years due to its worldwide prevalence. It is caused by species of the Scedosporium apiospermum complex. These species can cause opportunistic infections in immunocompromised patients and, occasionally, in immunocompetent patients as well. The high intrinsic antifungal resistance make these infections difficult to manage. Aims The objective of this study was to interpret the mycological findings in a transplant patient, together with the images obtained in the radiological studies, in order to provide an early and effective antifungal therapy. Methods The mycological analysis of samples taken from a heart transplant patient with radiological images suggesting a fungal infection was performed. Computed tomography scan of the head and thorax showed space-occupying lesions in both the frontal lobe and cerebellum, and multiple pulmonary nodules. The nodules were punctured and the samples obtained were analyzed according to the procedures for mycological analysis. The identity of the isolates was confirmed by nucleotide sequencing. Eventually, the antifungal susceptibility was studied. Results The fungal isolates obtained, whose identity was confirmed by sequencing, belonged to the species Scedosporium boydii. Injured tissues were surgically removed and a treatment with amphotericin B and voriconazole-minimum inhibitory concentration (MIC) 0.5μg/mL and ≥0.5μg/mL respectively – was administered. Conclusions Although the patient died due to complications of a Klebsiella pneumoniae sepsis refractory to treatment, the progression of the fungal disease, although slow, was favourable in the early phases of the treatment due to a correct diagnosis and the antifungal susceptibility test carried out. ... (AU)

Antecedentes La escedosporiasis es una micosis emergente de relevancia en los últimos años por su prevalencia mundial. Es causada por especies del complejo Scedosporium apiospermum (S. apiospermum), que pueden provocar infecciones oportunistas de difícil tratamiento en pacientes inmunocomprometidos y, ocasionalmente, en inmunocompetentes. El alto grado de resistencia intrínseca de las especies de este complejo dificulta el manejo de las infecciones. Objetivos Interpretar los hallazgos micológicos en un paciente trasplantado, en conjunción con los estudios radiológicos, a fin de instaurar una terapia antifúngica precoz y efectiva. Métodos Se realizó el estudio micológico de muestras de un paciente con trasplante cardiaco, cuyos exámenes radiológicos eran compatibles con una infección fúngica. La tomografía axial computarizada de cabeza y tórax mostró masas ocupantes en el lóbulo frontal y el cerebelo, así como múltiples nódulos pulmonares. Se punzaron las mismas y se procesó de acuerdo con el protocolo de análisis micológico de rutina; la identidad de los aislamientos se confirmó por secuenciación nucleotídica. Finalmente se evaluó la sensibilidad antifúngica. Resultados La identidad de los aislamientos fúngicos obtenidos fue Scedosporium boydii (S. boydii). Se procedió a la remoción quirúrgica del tejido afectado y se puso un tratamiento con anfotericina B y voriconazol, para los cuales los valores de concentración inhibitoria mínima del aislamiento fueron 0,5 μg/mL y ≥ 0,5 μg/mL, respectivamente. Conclusiones Si bien el paciente falleció por complicaciones asociadas a sepsis por Klebsiella pneumoniae (K. pneumoniae) refractaria al tratamiento, la evolución del cuadro micológico, aun siendo lenta, progresó favorablemente en las primeras fases del tratamiento. Esto se atribuye a un correcto diagnóstico y evaluación de la sensibilidad antifúngica del hongo aislado. ... (AU)

Scedosporium boydii finding in an immunocompromised patient and review of the literature.

BACKGROUND: Scedosporiasis is an emerging mycosis that has gained importance in recent years due to its worldwide prevalence. It is caused by species of the Scedosporium apiospermum complex. These species can cause opportunistic infections in immunocompromised patients and, occasionally, in immunocompetent patients as well. The high intrinsic antifungal resistance make these infections difficult to manage. AIMS: The objective of this study was to interpret the mycological findings in a transplant patient, together with the images obtained in the radiological studies, in order to provide an early and effective antifungal therapy. METHODS: The mycological analysis of samples taken from a heart transplant patient with radiological images suggesting a fungal infection was performed. Computed tomography scan of the head and thorax showed space-occupying lesions in both the frontal lobe and cerebellum, and multiple pulmonary nodules. The nodules were punctured and the samples obtained were analyzed according to the procedures for mycological analysis. The identity of the isolates was confirmed by nucleotide sequencing. Eventually, the antifungal susceptibility was studied. RESULTS: The fungal isolates obtained, whose identity was confirmed by sequencing, belonged to the species Scedosporium boydii. Injured tissues were surgically removed and a treatment with amphotericin B and voriconazole-minimum inhibitory concentration (MIC) 0.5µg/mL and ≥0.5µg/mL respectively - was administered. CONCLUSIONS: Although the patient died due to complications of a Klebsiella pneumoniae sepsis refractory to treatment, the progression of the fungal disease, although slow, was favourable in the early phases of the treatment due to a correct diagnosis and the antifungal susceptibility test carried out. Clinical cases of this nature highlight the need to increase the epidemiological study of these microorganisms, as well as the proper treatment of the diseases caused, in order to achieve early diagnoses that reduce the morbidity and mortality of patients.

[Optimization of variables in photodynamic antifungal assays against Candida species]. / Optimización de variables en ensayos de actividad antifúngica fotodinámica frente a especies de Candida.

Oral infections due to yeasts of the genus Candida are very common in patients with predisposing factors, such as physiological conditions or certain underlying diseases. Moreover, oral candidiasis can also evolve into disseminated forms. In this work, strains of the genus Candida were studied to establish the optimal radiation conditions for photosensitizing compounds, in a photodynamic antifungal therapy protocol. A total of 39 isolates were evaluated. The strains were exposed to twelve dyestuffs, eight radiation sources and three different exposure times. Orthotoluidine blue exhibited good photodynamic activity, in combination with exposure to a 20W reflector lamp LED (light-emitting diode) light for 60minutes. When considering the difficulties of using conventional antifungal drugs, the emergence of resistant strains, recurrences, and adverse reactions of certain commonly used drugs, the photodynamic antifungal therapy is a promising strategy for the treatment of localized infections.

Onicomicosis en pacientes con VIH / Onychomycosis in HIV - Positive patients

Las onicomicosis son un grupo de afecciones ungueales causadas por dermatofitos, levaduras y hongos no dermatofitos, que pueden confundirse con otras onicopatías. Objetivos. 1. Aislar e identificar los hongos presentes en uñas de manos y pies en un grupo depacientes con infección por VIH que presenten lesiones compatibles con onicomicosis. 2. Comparar estos hallazgos con la microbiota presente en pacientes también VIH positivos pero que noevidencien clínica de onicomicosis. 3. Evaluar la asociación entre la afectación ungueal y diversas variables propias de la patología de base, como la cantidad de células CD4, carga viral, terapiaantirretroviral y otras comorbilidades.Materiales y métodos. En este estudio descriptivo, prospectivo, observacional, se evaluaron pacientes con y sin lesiones ungueales. Se observó el grado de afectación y se tomaron muestras deescamas de uñas, sometiéndolas a análisis micológico de rutina. Resultados. Se observó mayor frecuencia de onicomicosis en pacientes con carga viral mayor a 50copias/ml; así se obtuvo una asociación estadísticamente significativa entre estas variables (p <0,05), no observándose asociación entre la presencia de onicomicosis y el nivel de CD4 en sangre.Conclusiones. Destacamos la importancia de realizar el estudio micológico en pacientes VIH con onicopatías, debido a que hay diversas causas de afectación del lecho ungueal, más aún teniendoen cuenta los fracasos terapéuticos, las recidivas y las interacciones medicamentosas entre agentesantimicóticos y antirretrovirales. Dado que en este estudio preliminar encontramos asociaciones estadísticamente significativas entre algunas de las variables estudiadas, continuaremos con este trabajo con el fin de poder ampliar la información disponible sobre la etiopatogenia de las lesiones ungueales en pacientes VIH positivos...

Prevalencia de especies de Malassezia en pacientes con Pitiriasis versicolor en Rosario, Argentina / Prevalence of Malassezia species in patients with pityriasis versicolor in Rosario, Argentina

Antecedentes. Las especies de Malassezia son consideradas levaduras oportunistas de importancia clínica creciente. Estas levaduras lipófilas están asociadas con diversas enfermedades humanas, especialmente la pitiriasis versicolor (PV), una dermatomicosis superficial crónica. Objetivos. El objetivo de este estudio fue aislar, identificar y analizar la distribución de diferentes especies de Malassezia en pacientes con PV en la ciudad de Rosario, Argentina. Métodos. Se estudiaron 264 muestras clínicas y los aislamientos fueron identificados según la observación microscópica de las células, propiedades fisiológicas tales como, presencia de catalasa, habilidad para utilizar compuestos Tween, desdoblamiento de la esculina y la descripción del color, morfología y formación de precipitado empleando el medio cromógeno CHROMagar Malassezia (CHROMM). Resultados. La mayor prevalencia de PV, en este estudio, fue encontrada en el grupo de 25-45 años de edad, no encontrandose diferencias con respecto al sexo. Las áreas más afectadas fueron tronco y cara. Malassezia sympodialis (51%) fue la especie más aislada, seguida por Malassezia globosa (40%), Malassezia furfur (7%), Malassezia obtusa (1%) y Malassezia slooffiae (1%). Conclusiones. La importancia de una correcta identificación de estas levaduras es necesaria para el conocimiento de su rol epidemiológico en la PV y también para detectar la presencia de cepas resistentes a los antifúngicos(AU)

Background. Malassezia species are considered opportunistic yeasts of increasing clinical importance. These lipophilic yeasts are associated with various human diseases, especially pityriasis versicolor (PV), a chronic superficial scaling dermatomycosis. Aims. The aim of this study was to isolate, identify and analyze the distribution of the different species of Malassezia in patients with PV in Rosario city (Argentina). Methods. A total of 264 clinical samples were studied. Isolates were identified on the basis of microscopic observation of cells, and physiological properties, such as the presence of catalase, ability to use Tween compounds, splitting of esculin, and morphology, color and precipitate production on chromogenic agar CHROMagar-Malassezia medium (CHROMM). Results. The highest prevalence of PV in this study was observed in the 25- to 45-year-old group. No differences were found in the development of PV between sexes. The most affected areas of body were the trunk and face. Malassezia sympodialis (51%) was the most commonly isolated species, followed in frequency by M. globosa (40%), Malassezia furfur (7%), Malassezia obtusa (1%) and Malassezia slooffiae (1%). Conclusions. The success for a correct identification of these yeasts is important to improve our knowledge about their epidemiological role in PV and also to detect the appearance of strains which are resistant to the commonly used antifungal drugs(AU)

Prevalence of Malassezia species in patients with pityriasis versicolor in Rosario, Argentina.

BACKGROUND: Malassezia species are considered opportunistic yeasts of increasing clinical importance. These lipophilic yeasts are associated with various human diseases, especially pityriasis versicolor (PV), a chronic superficial scaling dermatomycosis. AIMS: The aim of this study was to isolate, identify and analyze the distribution of the different species of Malassezia in patients with PV in Rosario city (Argentina). METHODS: A total of 264 clinical samples were studied. Isolates were identified on the basis of microscopic observation of cells, and physiological properties, such as the presence of catalase, ability to use Tween compounds, splitting of esculin, and morphology, color and precipitate production on chromogenic agar CHROMagar-Malassezia medium (CHROMM). RESULTS: The highest prevalence of PV in this study was observed in the 25- to 45-year-old group. No differences were found in the development of PV between sexes. The most affected areas of body were the trunk and face. Malassezia sympodialis (51%) was the most commonly isolated species, followed in frequency by M. globosa (40%), Malassezia furfur (7%), Malassezia obtusa (1%) and Malassezia slooffiae (1%). CONCLUSIONS: The success for a correct identification of these yeasts is important to improve our knowledge about their epidemiological role in PV and also to detect the appearance of strains which are resistant to the commonly used antifungal drugs.

[Conservation of Malassezia strains in blotting paper]. / Empleo de discos de papel secante para la conservación de cepas de Malassezia spp.

Reference strains belonging to the genus Malassezia were analyzed to evaluate, by comparison, different preservation systems such us subculture, freezing at -80 degrees C in glycerol, and blotting paper-disc conservation. The viability, phenotypic and genotypic characteristics of the strains used in this study was evaluated. The blotting paper method was found to be advantageous to preserve Malassezia spp strains due to both, its simple implementation in the laboratory and its efficiency.

Identificación y epidemiología de las distintas especies de Malassezia en la ciudad de Rosario / Identification and epidemiology of the different species of Malassezia in the city of Rosario, Argentina

Las especies del género Malassezia han sido exhaustivamente estudiadas en estos últimos años, tanto desde el punto de vista fenotípico como desde las pruebas fisiológicas y características genotípicas. En tal sentido, se han incorporado las especies M. Globosa, M. slooffiae, M. restricta y M. obtusa a las ya conocidas M. furfur, M. pachydermatis y M. sympodialis. El objetivo de este trabajo fue, teniendo en cuenta estos estudios taxonómicos, identificar las distintas especies de Malassezia en muestras provenientes de pacientes con pitiriasis versicolor, dermatitis seborreica y foliculitis que consultaron al Servicio de Dermatología, en el Hospital Provincial "Centenario" de Rosario. Las especies más frecuentemente halladas en la población estudiada fueron M. sympodialis, seguida por M obtusa, M. slooffiae y, con menor frecuencia, M furfur.

Aflatoxin B1 content in patients with hepatic diseases.

Aflatoxins are toxic metabolites of some Aspergillus flavus, A. parasiticus and A. nomius strains that occur in many foods and feeds. There are four major natural occurring aflatoxins: B1, B2, G1 and G2. These toxins can cause illness in human beings and animals. Aflatoxin B1 is the most abundant and toxic member of the family, and it is also the most potent hepatocarcinogen known. In order to estimate the potential human health risk of AFB1, it is useful to measure blood concentration. The presence of aflatoxin B1 in patients was evaluated by high-performance liquid chromatography, in serum samples, obtained from 20 patient volunteers with hepatic disease. Out of the 20 patients, the presence of AFB1 was detected in only one of them, in a concentration of 0.47 ng/cm3. Nevertheless, this result should draw the attention of control organizations in Argentina to the need for a thorough food and feed inspection.

Aflatoxin B1 content in patients with hepatic diseases

Aflatoxins are toxic metabolites of some Aspergillus flavus, A. parasiticus and A. nomius strains that occur in many foods and feeds. There are four major natural occurring aflatoxins: B1, B2, G1 and G2. These toxins can cause illness in human beings and animals. Aflatoxin B1 is the most abundant and toxic member of the family, and it is also the most potent hepatocarcinogen known. In order to estimate the potential human health risk of AFB1, it is useful to measure blood concentration. The presence of aflatoxin B1 in patients was evaluated by high-performance liquid chromatography, in serum samples, obtained from 20 patient volunteers with hepatic disease. Out of the 20 patients, the presence of AFB1 was detected in only one of them, in a concentration of 0.47 ng/cm3. Nevertheless, this result should draw the attention of control organizations in Argentina to the need for a thorough food and feed inspection

Aflatoxin B1 content in patients with hepatic diseases

Aflatoxins are toxic metabolites of some Aspergillus flavus, A. parasiticus and A. nomius strains that occur in many foods and feeds. There are four major natural occurring aflatoxins: B1, B2, G1 and G2. These toxins can cause illness in human beings and animals. Aflatoxin B1 is the most abundant and toxic member of the family, and it is also the most potent hepatocarcinogen known. In order to estimate the potential human health risk of AFB1, it is useful to measure blood concentration. The presence of aflatoxin B1 in patients was evaluated by high-performance liquid chromatography, in serum samples, obtained from 20 patient volunteers with hepatic disease. Out of the 20 patients, the presence of AFB1 was detected in only one of them, in a concentration of 0.47 ng/cm3. Nevertheless, this result should draw the attention of control organizations in Argentina to the need for a thorough food and feed inspection (AU)

Aflatoxin B1 content in patients with hepatic diseases.

Aflatoxins are toxic metabolites of some Aspergillus flavus, A. parasiticus and A. nomius strains that occur in many foods and feeds. There are four major natural occurring aflatoxins: B1, B2, G1 and G2. These toxins can cause illness in human beings and animals. Aflatoxin B1 is the most abundant and toxic member of the family, and it is also the most potent hepatocarcinogen known. In order to estimate the potential human health risk of AFB1, it is useful to measure blood concentration. The presence of aflatoxin B1 in patients was evaluated by high-performance liquid chromatography, in serum samples, obtained from 20 patient volunteers with hepatic disease. Out of the 20 patients, the presence of AFB1 was detected in only one of them, in a concentration of 0.47 ng/cm3. Nevertheless, this result should draw the attention of control organizations in Argentina to the need for a thorough food and feed inspection.